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Hecker M, Fitzner B, Koczan D, Klehmet J, Grothe M, Schwab M, Winkelmann A, Meister S, Dudesek A, Ludwig-Portugall I, Eulitz K, Zettl UK. Differential gene expression in B cells and T helper cells following high-dose glucocorticoid therapy for multiple sclerosis relapse. Biomed Pharmacother 2024; 175:116721. [PMID: 38749180 DOI: 10.1016/j.biopha.2024.116721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Despite remarkable advances in the therapy of multiple sclerosis (MS), patients with MS may still experience relapses. High-dose short-term methylprednisolone (MP) remains the standard treatment in the acute management of MS relapses due to its potent anti-inflammatory and immunosuppressive properties. However, there is a lack of studies on the cell type-specific transcriptome changes that are induced by this synthetic glucocorticoid (GC). Moreover, it is not well understood why some patients do not benefit adequately from MP therapy. METHODS We collected peripheral blood from MS patients in relapse immediately before and after ∼3-5 days of therapy with MP at 4 study centers. CD19+ B cells and CD4+ T cells were then isolated for profiling the transcriptome with high-density arrays. The patients' improvement of neurological symptoms was evaluated after ∼2 weeks by the treating physicians. We finally analyzed the data to identify genes that were differentially expressed in response to the therapy and whose expression differed between clinical responders and non-responders. RESULTS After MP treatment, a total of 33 genes in B cells and 55 genes in T helper cells were significantly up- or downregulated. The gene lists overlap in 10 genes and contain genes that have already been described as GC-responsive genes in the literature on other cell types and diseases. Their differential expression points to a rapid and coordinated modulation of multiple signaling pathways that influence transcription. Genes that were previously suggested as potential prognostic biomarkers of the clinical response to MP therapy could not be confirmed in our data. However, a greater increase in the expression of genes encoding proteins with antimicrobial activity was detected in CD4+ T cells from non-responders compared to responders. CONCLUSION Our study delved into the cell type-specific effects of MP at the transcriptional level. The data suggest a therapy-induced ectopic expression of some genes (e.g., AZU1, ELANE and MPO), especially in non-responders. The biological consequences of this remain to be explored in greater depth. A better understanding of the molecular mechanisms underlying clinical recovery from relapses in patients with MS will help to optimize future treatment decisions.
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Affiliation(s)
- Michael Hecker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.
| | - Brit Fitzner
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Dirk Koczan
- Institute of Immunology, Rostock University Medical Center, Rostock, Germany
| | - Juliane Klehmet
- Center for Multiple Sclerosis, Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Winkelmann
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Stefanie Meister
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Ales Dudesek
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | | | | | - Uwe Klaus Zettl
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Tan LY, Cunliffe G, Hogan MP, Yeo XY, Oh C, Jin B, Kang J, Park J, Kwon MS, Kim M, Jung S. Emergence of the brain-border immune niches and their contribution to the development of neurodegenerative diseases. Front Immunol 2024; 15:1380063. [PMID: 38863704 PMCID: PMC11165048 DOI: 10.3389/fimmu.2024.1380063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
Historically, the central nervous system (CNS) was regarded as 'immune-privileged', possessing its own distinct immune cell population. This immune privilege was thought to be established by a tight blood-brain barrier (BBB) and blood-cerebrospinal-fluid barrier (BCSFB), which prevented the crossing of peripheral immune cells and their secreted factors into the CNS parenchyma. However, recent studies have revealed the presence of peripheral immune cells in proximity to various brain-border niches such as the choroid plexus, cranial bone marrow (CBM), meninges, and perivascular spaces. Furthermore, emerging evidence suggests that peripheral immune cells may be able to infiltrate the brain through these sites and play significant roles in driving neuronal cell death and pathology progression in neurodegenerative disease. Thus, in this review, we explore how the brain-border immune niches may contribute to the pathogenesis of neurodegenerative disorders such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). We then discuss several emerging options for harnessing the neuroimmune potential of these niches to improve the prognosis and treatment of these debilitative disorders using novel insights from recent studies.
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Affiliation(s)
- Li Yang Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace Cunliffe
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Michael Patrick Hogan
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Xin Yi Yeo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chansik Oh
- Department of Medical Science, College of Medicine, CHA University, Seongnam, Republic of Korea
| | - Bohwan Jin
- Department of Medical Science, College of Medicine, CHA University, Seongnam, Republic of Korea
| | - Junmo Kang
- Department of Medical Science, College of Medicine, CHA University, Seongnam, Republic of Korea
| | - Junho Park
- Department of Pharmacology, Research Institute for Basic Medical Science, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Min-Soo Kwon
- Department of Pharmacology, Research Institute for Basic Medical Science, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - MinYoung Kim
- Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea
- Department of Biomedical Science, CHA University School of Medicine, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Sangyong Jung
- Department of Medical Science, College of Medicine, CHA University, Seongnam, Republic of Korea
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Bagnoud M, Remlinger J, Joly S, Massy M, Salmen A, Chan A, Karathanassis D, Evangelopoulos M, Hoepner R. Predicting glucocorticoid resistance in multiple sclerosis relapse via a whole blood transcriptomic analysis. CNS Neurosci Ther 2024; 30:e14484. [PMID: 37817393 PMCID: PMC10848073 DOI: 10.1111/cns.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/30/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
AIMS Treatment of multiple sclerosis (MS) relapses consists of short-term administration of high-dose glucocorticoids (GCs). However, over 40% of patients show an insufficient response to GC treatment. We aimed to develop a predictive model for such GC resistance. METHODS We performed a receiver operating characteristic (ROC) curve analysis following the transcriptomic assay of whole blood samples from stable, relapsing GC-sensitive and relapsing GC-resistant patients with MS in two different European centers. RESULTS We identified 12 genes being regulated during a relapse and differentially expressed between GC-sensitive and GC-resistant patients with MS. Using these genes, we defined a statistical model to predict GC resistance with an area under the curve (AUC) of the ROC analysis of 0.913. Furthermore, we observed that relapsing GC-resistant patients with MS have decreased GR, DUSP1, and TSC22D3 mRNA levels compared with relapsing GC-sensitive patients with MS. Finally, we showed that the transcriptome of relapsing GC-resistant patients with MS resembles those of stable patients with MS. CONCLUSION Predicting GC resistance would allow patients to benefit from prompt initiation of an alternative relapse treatment leading to increased treatment efficacy. Thus, we think our model could contribute to reducing disability development in people with MS.
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Affiliation(s)
- Maud Bagnoud
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Jana Remlinger
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Sandrine Joly
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Marine Massy
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
- Graduate School for Cellular and Biomedical SciencesUniversity of BernBernSwitzerland
| | - Anke Salmen
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Andrew Chan
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Dimitris Karathanassis
- Department of Neurology, Eginition HospitalNational and Kapodistrian University of AthensAthensGreece
| | | | - Robert Hoepner
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
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Verbout NG, Su W, Pham P, Jordan KR, Kohs TCL, Tucker EI, McCarty OJT, Sherman LS. Cytoprotective E-WE thrombin reduces disease severity in a murine model of relapsing-remitting multiple sclerosis. Am J Physiol Cell Physiol 2024; 326:C40-C49. [PMID: 37955120 DOI: 10.1152/ajpcell.00377.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
The blood-brain barrier is composed of microvascular endothelial cells, immune cells, and astrocytes that work in concert with the coagulation cascade to control inflammation and immune cell infiltration into the central nervous system. Endothelial cell dysfunction leading to increased permeability and compromised barrier function are hallmarks of neuroinflammatory and autoimmune disorders, including multiple sclerosis (MS). Therapeutic strategies that improve or protect endothelial barrier function may be beneficial in the treatment or prevention of neuroinflammatory diseases. We therefore tested the hypothesis that biasing thrombin toward anticoagulant and cytoprotective activities would provide equivalent or even additive benefit compared with standard-of-care therapeutic strategies, including corticosteroids. In a mouse model of relapsing-remitting MS, treatment with the thrombin mutant, E-WE thrombin, an engineered thrombin mutant with cytoprotective activities that is biased toward anticoagulant and cytoprotective activity, reduced neuroinflammation and extracellular fibrin formation in SJL mice inoculated with proteolipid protein (PLP) peptide. When administered at the onset of detectable disease, E-WE thrombin significantly improved the disease severity of the initial attack as well as the relapse and delayed the onset of relapse to a similar extent as observed with methylprednisolone. Both methylprednisolone and E-WE thrombin reduced demyelination and immune cell recruitment. These results provide rationale for considering engineered forms of thrombin biased toward anticoagulant and cytoprotective activity as a therapeutic strategy and perhaps an effective alternative to high-dose methylprednisolone for the management of acute relapsing MS attacks.NEW & NOTEWORTHY There are limited treatment options for mitigating acute relapsing attacks for patients with multiple sclerosis. We tested the hypothesis that harnessing the cytoprotective activity of the blood coagulation enzyme, thrombin, would provide benefit and protection against relapsing disease in a mouse model of MS. Our results provide rationale for considering engineered forms of thrombin biased toward cytoprotective activity as a therapeutic strategy and perhaps an alternative to steroids for the management of relapsing MS attacks.
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Affiliation(s)
- Norah G Verbout
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
- Aronora, Inc, Portland, Oregon, United States
| | - Weiping Su
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Peter Pham
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Kelley R Jordan
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Tia C L Kohs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Erik I Tucker
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
- Aronora, Inc, Portland, Oregon, United States
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Larry S Sherman
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
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Raja K, Prabahar A, Arputhanatham SS. A Simple Computational Approach to Identify Potential Drugs for Multiple Sclerosis and Cognitive Disorders from Expert Curated Resources. Methods Mol Biol 2022; 2496:111-121. [PMID: 35713861 DOI: 10.1007/978-1-0716-2305-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multiple sclerosis, a disease of central nervous system leads to potential disability. In the USA, one million cases are diagnosed with multiple sclerosis in 2019. Multiple sclerosis is identified as one of the diseases causing global burden. Cognitive disorder is highly prevalent among 43-70% of multiple sclerosis patients. However, treating cognitive disorder in multiple sclerosis patients is mostly ignored and this leads to several complications. We utilized various expert curated resources to identify potential drugs for multiple sclerosis and cognitive disorder, with specific focus on identifying drugs that are capable of treating both the conditions. We used simple text mining techniques to compile two databases, disease-drug association database and gene-drug interaction database from various existing standard resources. Our study suggests four drugs, Baclofen, Levodopa, Minocycline, and Vitamin B12, for treating both multiple sclerosis and cognitive disorder. In addition, our approach suggests six drugs for multiple sclerosis and 10 drugs for cognitive disorder. We obtained pharmacologist opinion on the drugs suggested for each condition and provided literature evidence for our claim. Here, we present our computational approach as a protocol such that it can be applied to other comorbid diseases that did not gain much attention so far.
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Affiliation(s)
- Kalpana Raja
- Regenerative Biology, The Morgridge Institute for Research, Madison, WI, USA.
| | - Archana Prabahar
- R&D Division, Eriks-Precision Components India Pvt Ltd, Mohali, Punjab, India
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Jaiswal AK, Yadav J, Makhija S, Sandey M, Suryawanshi A, Mitra AK, Mishra A. Short Palate, Lung, and Nasal Epithelial Clone1 (SPLUNC1) level determines steroid-resistant airway inflammation in aging. Am J Physiol Lung Cell Mol Physiol 2021; 322:L102-L115. [PMID: 34851736 PMCID: PMC8759962 DOI: 10.1152/ajplung.00315.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Asthma and its heterogeneity change with age. Increased airspace neutrophil numbers contribute to severe steroid-resistant asthma exacerbation in the elderly, which correlates with the changes seen in adults with asthma. However, whether that resembles the same disease mechanism and pathophysiology in aged and adults is poorly understood. Here, we sought to address the underlying molecular mechanism of steroid-resistant airway inflammation development and response to corticosteroid (Dex) therapy in aged mice. To study the changes in inflammatory mechanism, we used a clinically relevant treatment model of house-dust mite (HDM)-induced allergic asthma and investigated lung adaptive immune response in adult (20–22 wk old) and aged (80–82 wk old) mice. Our result indicates an age-dependent increase in airway hyperresponsiveness (AHR), mixed granulomatous airway inflammation comprising eosinophils and neutrophils, and Th1/Th17 immune response with progressive decrease in frequencies and numbers of HDM-bearing dendritic cells (DC) accumulation in the draining lymph node (DLn) of aged mice as compared with adult mice. RNA-Seq experiments of the aged lung revealed short palate, lung, and nasal epithelial clone 1 (SPLUNC1) as one of the steroid-responsive genes, which progressively declined with age and further by HDM-induced inflammation. Moreover, we found increased glycolytic reprogramming, maturation/activation of DCs, the proliferation of OT-II cells, and Th2 cytokine secretion with recombinant SPLUNC1 (rSPLUNC1) treatment. Our results indicate a novel immunomodulatory role of SPLUNC1 regulating metabolic adaptation/maturation of DC. An age-dependent decline in the SPLUNC1 level may be involved in developing steroid-resistant airway inflammation and asthma heterogeneity.
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Affiliation(s)
- Anil Kumar Jaiswal
- Laboratory of Lung Inflammation, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.,Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Jyoti Yadav
- Laboratory of Lung Inflammation, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.,Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Sangeet Makhija
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Maninder Sandey
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Amol Suryawanshi
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Amit Kumar Mitra
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States.,Center for Pharmacogenomics and Single-Cell Omics, Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
| | - Amarjit Mishra
- Laboratory of Lung Inflammation, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.,Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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7
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Wicks CR, Sloan R, DiMauro S, Thompson EL, Billington S, Webb M, Pepper G. Patients' experiences of self-identification, seeking support, and anticipation of potential relapse in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103259. [PMID: 34628265 DOI: 10.1016/j.msard.2021.103259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) relapses are associated with increased disability, reduced quality of life and negative psychosocial impacts. However, they often go unrecognised; people with MS (MSers) may face barriers to self-identification of relapses or seeking support for them. The charity Shift.ms sought to better understand 1) MSers' challenges in self-identifying potential relapses, 2) where MSers' seek support for potential relapses, and 3) the impact of the anticipation of relapses on MSers' wellbeing and daily living. METHODS Shift.ms developed a patient perspective 8-question pilot survey (included likert-style, multiple-choice, and optional free-text responses) and shared it with Shift.ms' international online community (n = 20,052). Descriptive quantitative analysis, and content analysis and thematic analysis of qualitative free-text responses were used. RESULTS 1,737 MSers responded. Just under one third (29.9%) of MSers reported that it takes them 24 h or less to self-identify a potential relapse, while more than half (54.5%) reported that identification occurs within 48 h; 55% MSers felt that the "at least 24 h" clinical criterion of relapse classification was appropriate. Challenges to relapse self-identification included confounding background symptoms or infection, variability of relapse symptoms, and individualistic nature of MS. Fatigue was reported to be the most common symptom of relapse (75%), however fatigue was also the symptom most commonly mistaken for relapse (40%). Barriers to relapse self-identification were a shorter duration since MS diagnosis and a perceived lack of consensus around relapse classification. Respondents reported they most often seek relapse support/advice from healthcare professionals (HCPs) (37.1%), family/friends (32.1%), or not at all (16.9%). Rather than temporal criteria (i.e. the 24 h criterion), participants felt that severity of symptoms could play a more critical role in whether to seek support for a potential relapse. Barriers to seeking support/advice included variability in HCP advice and feelings of invalidation. Anticipation of relapses negatively impacted MSers wellbeing; led to reduced participation in activities, and the development of adjustment/coping strategies. Relapse triggers included stress, reduced self-care, infection/illness; 78.5% reported stress or anxiety had triggered relapse. CONCLUSIONS These findings highlight difficulties MSers face in self-identifying relapses, barriers to accessing support, and impact of anticipation of relapses. They also highlight opportunities for improved MSer and HCP communication, dialogue and two-way education to help optimise patient access to relapse support and intervention.
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Affiliation(s)
| | - Rob Sloan
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Sophie DiMauro
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | | | - Sam Billington
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Mark Webb
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - George Pepper
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK.
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Ashtari F, Soltani R, Shokouhi S, Rismanbaf A, Hajiahmadi S, Hakamifard A. Adverse reaction of methylprednisolone pulse therapy: Acute respiratory distress syndrome. Clin Case Rep 2021; 9:e04468. [PMID: 34295489 PMCID: PMC8283859 DOI: 10.1002/ccr3.4468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
Methylprednisolone pulse therapy has significant anti-inflammatory effects in multiple sclerosis. Acute respiratory distress syndrome as a probable adverse effect of methylprednisolone pulse therapy in MS patients should be considered.
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Affiliation(s)
- Fereshteh Ashtari
- Isfahan Neuroscience Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Rasool Soltani
- Department of Clinical Pharmacy and Pharmacy PracticeSchool of Pharmacy and Pharmaceutical SciencesIsfahan University of Medical SciencesIsfahanIran
| | - Shervin Shokouhi
- Department of Infectious Diseases and Tropical MedicineLoghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Rismanbaf
- Department of Clinical Pharmacy and Pharmacy PracticeSchool of Pharmacy and Pharmaceutical SciencesIsfahan University of Medical SciencesIsfahanIran
| | - Somayeh Hajiahmadi
- Department of RadiologySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
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Marin-Luevano SP, Rodriguez-Carlos A, Jacobo-Delgado Y, Valdez-Miramontes C, Enciso-Moreno JA, Rivas-Santiago B. Steroid hormone modulates the production of cathelicidin and human β-defensins in lung epithelial cells and macrophages promoting Mycobacterium tuberculosis killing. Tuberculosis (Edinb) 2021; 128:102080. [PMID: 33799143 DOI: 10.1016/j.tube.2021.102080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Several studies have documented the interaction between the immune and endocrine systems as an effective defense strategy against tuberculosis, involving the production of several molecules and immunological processes. In this study, we determined the effect of cortisol and dehydroepiandrosterone (DHEA) on the production of antimicrobial peptides such as cathelicidin and human β-defensin (HBD) -2, and HBD-3 and their effect on intracellular growth of Mycobacterium tuberculosis (Mtb) in lung epithelial cells and macrophages. Our results showed that DHEA promotes the production of these antimicrobial peptides in infected cells, correlating with the decrease of Mtb bacilli loads. These results suggest the use of exogenous DHEA as an adjuvant for tuberculosis therapy.
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Affiliation(s)
- Sara P Marin-Luevano
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico; Center for Research in Health Sciences and Biomedicine, Autonomous University of San Luis Potosí, Mexico
| | - Adrian Rodriguez-Carlos
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | - Yolanda Jacobo-Delgado
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | | | - Jose A Enciso-Moreno
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | - Bruno Rivas-Santiago
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico.
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10
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Koetzier SC, van Langelaar J, Blok KM, van den Bosch TPP, Wierenga-Wolf AF, Melief MJ, Pol K, Siepman TA, Verjans GMGM, Smolders J, Lubberts E, de Vries HE, van Luijn MM. Brain-homing CD4 + T cells display glucocorticoid-resistant features in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e894. [PMID: 33037101 PMCID: PMC7577536 DOI: 10.1212/nxi.0000000000000894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
Objective To study whether glucocorticoid (GC) resistance delineates disease-relevant T helper (Th) subsets that home to the CNS of patients with early MS. Methods The expression of key determinants of GC sensitivity, multidrug resistance protein 1 (MDR1/ABCB1) and glucocorticoid receptor (GR/NR3C1), was investigated in proinflammatory Th subsets and compared between natalizumab-treated patients with MS and healthy individuals. Blood, CSF, and brain compartments from patients with MS were assessed for the recruitment of GC-resistant Th subsets using fluorescence-activated cell sorting (FACS), quantitative polymerase chain reaction (qPCR), immunohistochemistry, and immunofluorescence. Results An MS-associated Th subset termed Th17.1 showed a distinct GC-resistant phenotype as reflected by high MDR1 and low GR expression. This expression ratio was further elevated in Th17.1 cells that accumulated in the blood of patients with MS treated with natalizumab, a drug that prevents their entry into the CNS. Proinflammatory markers C-C chemokine receptor 6, IL-23R, IFN-γ, and GM-CSF were increased in MDR1-expressing Th17.1 cells. This subset predominated the CSF of patients with early MS, which was not seen in the paired blood or in the CSF from patients with other inflammatory and noninflammatory neurologic disorders. The potential of MDR1-expressing Th17.1 cells to infiltrate brain tissue was confirmed by their presence in MS white matter lesions. Conclusion This study reveals that GC resistance coincides with preferential CNS recruitment of pathogenic Th17.1 cells, which may hamper the long-term efficacy of GCs in early MS.
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Affiliation(s)
- Steven C Koetzier
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Jamie van Langelaar
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Katelijn M Blok
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Thierry P P van den Bosch
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Annet F Wierenga-Wolf
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marie-José Melief
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Kim Pol
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Theodora A Siepman
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Georges M G M Verjans
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Joost Smolders
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Erik Lubberts
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Helga E de Vries
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marvin M van Luijn
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands.
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11
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Cerqueira SR, Ayad NG, Lee JK. Neuroinflammation Treatment via Targeted Delivery of Nanoparticles. Front Cell Neurosci 2020; 14:576037. [PMID: 33192321 PMCID: PMC7555434 DOI: 10.3389/fncel.2020.576037] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
The lack of effective treatments for most neurological diseases has prompted the search for novel therapeutic options. Interestingly, neuroinflammation is emerging as a common feature to target in most CNS pathologies. Recent studies suggest that targeted delivery of small molecules to reduce neuroinflammation can be beneficial. However, suboptimal drug delivery to the CNS is a major barrier to modulate inflammation because neurotherapeutic compounds are currently being delivered systemically without spatial or temporal control. Emerging nanomaterial technologies are providing promising and superior tools to effectively access neuropathological tissue in a controlled manner. Here we highlight recent advances in nanomaterial technologies for drug delivery to the CNS. We propose that state-of-the-art nanoparticle drug delivery platforms can significantly impact local CNS bioavailability of pharmacological compounds and treat neurological diseases.
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Affiliation(s)
- Susana R Cerqueira
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Nagi G Ayad
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jae K Lee
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
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12
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Rassy D, Bárcena B, Pérez-Osorio IN, Espinosa A, Peón AN, Terrazas LI, Meneses G, Besedovsky HO, Fragoso G, Sciutto E. Intranasal Methylprednisolone Effectively Reduces Neuroinflammation in Mice With Experimental Autoimmune Encephalitis. J Neuropathol Exp Neurol 2020; 79:226-237. [PMID: 31886871 DOI: 10.1093/jnen/nlz128] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 11/23/2019] [Indexed: 12/29/2022] Open
Abstract
Relapsing-remitting multiple sclerosis, the most common form, is characterized by acute neuroinflammatory episodes. In addition to continuous disease-modifying therapy, these relapses require treatment to prevent lesion accumulation and progression of disability. Intravenous methylprednisolone (1-2 g for 3-5 days) is the standard treatment for relapses. However, this treatment is invasive, requires hospitalization, leads to substantial systemic exposure of glucocorticoids, and can only reach modest concentrations in the central nervous system (CNS). Intranasal delivery may represent an alternative to deliver relapse treatment directly to the CNS with higher concentrations and reducing side effects. Histopathological analysis revealed that intranasal administration of methylprednisolone to mice with experimental autoimmune encephalomyelitis (EAE) suppressed the neuroinflammatory peak, and reduced immune cell infiltration and demyelination in the CNS similarly to intravenous administration. Treatment also downregulated Iba1 and GFAP expression. A similar significant reduction of IL-1β, IL-6, IL-17, IFN-γ, and TNF-α levels in the spinal cord was attained in both intranasal and intravenously treated mice. No damage in the nasal cavity was found after intranasal administration. This study demonstrates that intranasal delivery of methylprednisolone is as efficient as the intravenous route to treat neuroinflammation in EAE.
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Affiliation(s)
- Dunia Rassy
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | - Brandon Bárcena
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | - Iván Nicolás Pérez-Osorio
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | - Alejandro Espinosa
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | | | - Luis I Terrazas
- Unidad de Biomedicina.,Laboratorio Nacional en Salud, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Estado de México, Mexico
| | - Gabriela Meneses
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | - Hugo O Besedovsky
- Research Group Immunophysiology, Division of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps Universität, Marburg, Germany
| | - Gladis Fragoso
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
| | - Edda Sciutto
- From the Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City
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Chinea A, Honeycutt WD, Miller T, Graves D, Jacobs A, Wu J, LaGanke CC. Effect of Alemtuzumab Infusions on Vital Signs: A Prospective Observational Study in Patients with Relapsing-Remitting Multiple Sclerosis. Int J MS Care 2020; 22:53-59. [PMID: 32410899 DOI: 10.7224/1537-2073.2018-076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Alemtuzumab efficacy and safety were established in phase 3 randomized trials. We characterize vital signs during and after the first alemtuzumab infusion course. Methods Patients with relapsing-remitting multiple sclerosis commercially prescribed alemtuzumab 12 mg/day on 5 consecutive days (initial course) were enrolled in this prospective, observational study. Preinfusion medications included methylprednisolone, antihistamine, and antipyretics. Primary end point: change from precourse baseline in vital signs during and 2 hours after each alemtuzumab infusion. Secondary end points: infusion duration and serious adverse events (AEs) starting within 24 hours and within 7 days after infusion (AEs collected up to 15 days after treatment). Potentially clinically significant vital sign abnormalities were based on predefined thresholds from literature review. Results In the 304 patients treated, minimal increases in mean systolic (≤8 mm Hg) and diastolic (≤3 mm Hg) blood pressures from precourse baseline were observed on infusion days 3 to 5. An increase in mean heart rate (20 beats per minute) during the first infusion day normalized by day 2, and smaller increases (5 beats per minute) occurred during subsequent infusions. Serious AEs occurred in two patients (0.7%) during or within 24 hours after infusion and in three patients (1.0%) within 7 days. Mean/median infusion duration was 4 hours. Vital sign abnormalities with potential clinical significance occurred in 62.5% of patients. Conclusions Although most patients had potentially clinically significant vital sign abnormalities, mean changes from baseline during and after infusion of the first alemtuzumab course were clinically insignificant. No new safety signals were detected.
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14
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Immunoglobulin G index as a biomarker of relapse response to corticosteroids during early stages of multiple sclerosis. Mult Scler Relat Disord 2020; 38:101495. [DOI: 10.1016/j.msard.2019.101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022]
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15
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Shin JS, Kwon YN, Choi Y, Lee JY, Lee YI, Hwang JH, Choi SH, Kim SM. Comparison of psychiatric disturbances in patients with multiple sclerosis and neuromyelitis optica. Medicine (Baltimore) 2019; 98:e17184. [PMID: 31567960 PMCID: PMC6756707 DOI: 10.1097/md.0000000000017184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although both multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating diseases, their psychiatric disturbances may differ given differences in the neurological manifestations. We used subjective and objective measurements to compare the psychiatric disturbances in patients with MS and NMO.Psychiatric disturbances were assessed in 24 MS and 35 NMO patients using the Beck Hopelessness Scale, Symptom Checklist-95 and the brief version of World Health Organization Quality of Life. Personality was assessed using the Big Five Inventory-10. Disease-related function was assessed using the Fatigue Severity Scale, Short-Form McGill Pain Questionnaire, and the Global Assessment of Function. Positivity offset (PO) and negativity bias (NB) and heart rate variability (HRV) were measured using a modified implicit affect test and photoplethysmograph, respectively. Data were analyzed using analysis of covariance with age and sex as covariates.MS patients had higher levels of depression, anxiety, panic attacks, obsessive-compulsiveness, aggression, paranoia, interpersonal sensitivity, self-regulation problems, stress vulnerability, and lower psychological quality of life (QOL) compared with NMO patients. The PO and NB and HRV values were not significantly different between groups. However, NMO patients had lower QOL, and higher levels of hopelessness, suicidality, and fatigue than the normal range. Disease duration was associated with hopelessness in NMO patients and with several psychiatric disturbances, but not hopelessness, in MS patients.Subjective psychiatric disturbances were more severe in patients with MS than in those with NMO, whereas PO and NB and HRV in patients with NMO were comparable with those of MS patients. Our findings highlight the need for different clinical approaches to assess and treat psychiatric disturbances in patients with MS and NMO.
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Affiliation(s)
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital
| | | | | | | | | | - Soo-Hee Choi
- Department of Psychiatry
- Department of Psychiatry, Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital
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16
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Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2018; 25:309-315. [PMID: 30176401 DOI: 10.1016/j.msard.2018.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/27/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression and anxiety are common in multiple sclerosis (MS) and recently, studies on these symptoms in neuromyelitis optica spectrum disorder (NMOSD) are increasing. Previous studies suggest that these symptoms have negative effects on the quality of life. Resilience has garnered more interest as one of the protective factors that works to prevent psychiatric symptoms in past decades. There exist a few studies, however, regarding the effects of resilience on these psychiatric symptoms in MS/NMOSD. OBJECTIVE The aim of this study was to clarify the relationships between resilience, psychiatric symptoms, and QOL in patients with MS/NMOSD. METHOD Seventy-seven patients with MS/NMOSD participated in this study. They completed several questionnaires (Beck Depression Inventory-Second edition, Hospital Anxiety and Depression Scale, the Japanese version of the Resilience scale [RS], and Japanese version of Multiple Sclerosis Quality of Life-54). We also collected demographic and clinical data including age, sex, physical disability level (measured with the Expanded Disability Status Scale [EDSS]), and disease duration of the participants. RESULTS The EDSS scores showed significant negative correlations with QOL, unlike disease duration, which did not correlate with either the psychiatric symptoms or QOL. Additionally, there was no significant correlation between RS scores and EDSS scores or disease duration. We also found that resilience showed a significant negative correlation with psychiatric symptoms, and positive correlation with QOL. CONCLUSION These results suggest that resilience may serve to prevent or reduce depression/anxiety symptoms and maintain the QOL regardless of the physical disability level.
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Morris G, Reiche EMV, Murru A, Carvalho AF, Maes M, Berk M, Puri BK. Multiple Immune-Inflammatory and Oxidative and Nitrosative Stress Pathways Explain the Frequent Presence of Depression in Multiple Sclerosis. Mol Neurobiol 2018; 55:6282-6306. [PMID: 29294244 PMCID: PMC6061180 DOI: 10.1007/s12035-017-0843-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
Patients with a diagnosis of multiple sclerosis (MS) or major depressive disorder (MDD) share a wide array of biological abnormalities which are increasingly considered to play a contributory role in the pathogenesis and pathophysiology of both illnesses. Shared abnormalities include peripheral inflammation, neuroinflammation, chronic oxidative and nitrosative stress, mitochondrial dysfunction, gut dysbiosis, increased intestinal barrier permeability with bacterial translocation into the systemic circulation, neuroendocrine abnormalities and microglial pathology. Patients with MS and MDD also display a wide range of neuroimaging abnormalities and patients with MS who display symptoms of depression present with different neuroimaging profiles compared with MS patients who are depression-free. The precise details of such pathology are markedly different however. The recruitment of activated encephalitogenic Th17 T cells and subsequent bidirectional interaction leading to classically activated microglia is now considered to lie at the core of MS-specific pathology. The presence of activated microglia is common to both illnesses although the pattern of such action throughout the brain appears to be different. Upregulation of miRNAs also appears to be involved in microglial neurotoxicity and indeed T cell pathology in MS but does not appear to play a major role in MDD. It is suggested that the antidepressant lofepramine, and in particular its active metabolite desipramine, may be beneficial not only for depressive symptomatology but also for the neurological symptoms of MS. One clinical trial has been carried out thus far with, in particular, promising MRI findings.
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Affiliation(s)
- Gerwyn Morris
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Murru
- Bipolar Disorders Program, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
- Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria
- Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil
- Revitalis, Waalre, The Netherlands
- Orygen - The National Centre of Excellence in Youth Mental Health, The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Basant K Puri
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
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De Somma E, Jain RW, Poon KW, Tresidder KA, Segal JP, Ghasemlou N. Chronobiological regulation of psychosocial and physiological outcomes in multiple sclerosis. Neurosci Biobehav Rev 2018; 88:73-83. [DOI: 10.1016/j.neubiorev.2018.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/10/2018] [Accepted: 03/10/2018] [Indexed: 12/18/2022]
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Abstract
PURPOSE OF REVIEW This article discusses acute exacerbations (relapses) of multiple sclerosis (MS). Relapses are a hallmark of MS and are often associated with significant functional impairment and decreased quality of life. This review discusses the proposed pathophysiology of MS relapses, triggering factors, associated markers, variants of clinical presentation, and diagnostic recommendations. RECENT FINDINGS Most MS exacerbations are followed by a period of repair leading to clinical remission; however, residual deficits may persist after MS relapse and contribute to the stepwise progression of disability. Treatment of MS relapses is important as it helps to shorten the duration of disability associated with their course. Successful treatment of relapse helps patients with MS obtain a vital sense of being able to gain control over the disease. Patients with relapsing MS who receive treatment report better outcomes than those who are simply observed. This article discusses treatment options for MS relapse, including systemic corticosteroids, adrenocorticotropic hormone, and plasma exchange. Recent findings related to the mechanisms of action of steroids and adrenocorticotropic hormone are also reviewed, and other potential therapies are assessed. A proposed algorithm for MS relapse management is presented, including strategies for steroid-resistant MS exacerbations. SUMMARY MS relapses need to be recognized in a timely manner and treated using recommended therapeutic methods.
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Delgado-Roche L, Riera-Romo M, Mesta F, Hernández-Matos Y, Barrios JM, Martínez-Sánchez G, Al-Dalaien SM. Medical ozone promotes Nrf2 phosphorylation reducing oxidative stress and pro-inflammatory cytokines in multiple sclerosis patients. Eur J Pharmacol 2017. [PMID: 28623000 DOI: 10.1016/j.ejphar.2017.06.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Oxidative stress and inflammation play key roles in the pathogenesis of Multiple sclerosis (MS). Different drugs have been used in the clinical practice, however, there is not a completely effective treatment. Due to its potential therapeutic action, medical ozone represents a promising approach for neurodegenerative disorders. The aim of the present study was to address the role of ozone therapy on the cellular redox state in MS patients. Ozone (20μg/ml) was administered three times per week during a month by rectal insufflation. The effect of ozone therapy on biomarkers of oxidative stress and inflammation was addressed by spectrophotometric and immunoenzymatic assays. Furthermore, we investigated the action of ozone on CK2 expression and Nrf2 phosphorylation by western blotting analysis. Medical ozone significantly improved (P < 0.05) the activity of antioxidant enzymes and increased the levels of cellular reduced glutathione. In accordance, a significant reduction (P < 0.05) of oxidative damage on lipids and proteins was observed in ozone-treated patients. As well, the levels of pro-inflammatory cytokines TNFα and IL-1β were lower after ozone treatment. Ozone therapy incremented the CK2 expression together with Nrf2 phosphorylation in mononuclear cells of MS patients. These findings suggest that ozone´s antioxidant and anti-inflammatory effects might be partially associated with an induction of Nrf2 phosphorylation and activation. These results provide new insights on the molecular events modulated by ozone, and pointed out ozone therapy as a potential therapeutic alternative for MS patients.
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Affiliation(s)
- Livan Delgado-Roche
- Department of Pharmacology, Institute of Marine Sciences, Havana 10600, Cuba.
| | - Mario Riera-Romo
- Department of Pharmacology, Institute of Marine Sciences, Havana 10600, Cuba
| | - Fernando Mesta
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez 32315, Chihuahua, Mexico
| | | | - Juan M Barrios
- Laboratory of Oxidative Stress, Mexican Association of Oxidative Stress, Mexico D.F., Mexico
| | - Gregorio Martínez-Sánchez
- Medical Center Beauty Benefit - San Biagio di Osimo, Via Mons. Oscar Romero, 31, 60027 Osimo, Ancona, Italy
| | - Said M Al-Dalaien
- Department of Pharmacology, Medicine College, Mutah University, Jordan
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Banuelos J, Cao Y, Shin SC, Lu NZ. Immunopathology alters Th17 cell glucocorticoid sensitivity. Allergy 2017; 72:331-341. [PMID: 27646878 PMCID: PMC5315659 DOI: 10.1111/all.13051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
Th17 cells contribute to several inflammatory conditions and increasing evidence supports that Th17 cells are glucocorticoid resistant. However, Th17 cells in psoriasis and related diseases are glucocorticoid sensitive. We compare glucocorticoid sensitive and resistant immunological diseases and suggest that several aspects in Th17-related diseases alter glucocorticoid sensitivity of Th17 cells. We identify molecular pathways that are implicated in glucocorticoid sensitivity of Th17 cells in the literature, as this information is useful for developing approaches to overcome glucocorticoid-resistant immunopathology.
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Affiliation(s)
- J. Banuelos
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Y. Cao
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - S. C. Shin
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - N. Z. Lu
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kutz C. H.P. Acthar Gel (repository corticotropin injection) treatment of patients with multiple sclerosis and diabetes. Ther Adv Chronic Dis 2016; 7:190-7. [PMID: 27433309 PMCID: PMC4935834 DOI: 10.1177/2040622316644481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Treatment of multiple sclerosis (MS) relapses can be complex in patients with concomitant diabetes. Corticosteroids and adrenocorticotropic hormones are known to cause alterations in glucose tolerance. Many patients have poor tolerability to therapy, necessitating alternative treatment options. Adrenocorticotropic hormone (H.P. Acthar Gel, repository corticotropin injection, Mallinckrodt ARD Inc., Hazelwood, MO, USA) is currently indicated for the treatment of MS relapses. OBJECTIVES The objective of this study was to review patients' experiences of Acthar Gel for the treatment of MS exacerbations in patients with MS and diabetes. METHODS A retrospective review of 13 patients' experiences with treatment. Qualified healthcare providers completed a questionnaire following Acthar Gel treatment for MS relapse. RESULTS Previous corticosteroid treatment with either intravenous methylprednisolone or prednisone was reported by 84.6% of patients; eight patients had complications following administration of prior steroid treatment, seven of whom experienced elevated blood glucose levels. Acthar Gel was administered daily for a mean of 5.3 days, with 61.5% of patients reporting relapse resolution. Two patients experienced elevated blood glucose. CONCLUSION The majority of patients experienced a timely resolution of their MS relapse with few hyperglycemic adverse events. Although more studies are necessary, these data suggest that Acthar Gel may be a well-tolerated and effective treatment option for patients with diabetes experiencing an MS relapse.
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Affiliation(s)
- Christen Kutz
- Colorado Springs Neurological Associates, 2312 North Nevada Avenue, Colorado Springs, CO 80907, USA
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Magner WJ, Weinstock-Guttman B, Rho M, Hojnacki D, Ghazi R, Ramanathan M, Tomasi TB. Dicer and microRNA expression in multiple sclerosis and response to interferon therapy. J Neuroimmunol 2016; 292:68-78. [PMID: 26943961 PMCID: PMC4779496 DOI: 10.1016/j.jneuroim.2016.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/06/2016] [Accepted: 01/14/2016] [Indexed: 12/11/2022]
Abstract
Dysregulation of microRNA expression has been shown in multiple sclerosis (MS); however, the mechanisms underlying these changes, their response to therapy and the impact of microRNA changes in MS are not completely understood. Dicer mediates the cleavage of precursor microRNAs to mature microRNAs and is dysregulated in multiple pathologies. Having shown that interferons regulate Dicer in vitro, we hypothesized that MS patient IFNβ1a treatment could potentially alter Dicer expression. Dicer mRNA and protein levels, as well as microRNA expression, were determined in MS patient and healthy control PBL. Acute responses to IFNβ1a were assessed in 50 patients. We found that Dicer protein but not mRNA levels decreases in MS patients while both are selectively induced in patients responding well to IFNβ1a. Potential microRNA biomarkers for relapsing remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and IFNβ1a response are described. Contrasts in Dicer and microRNA expression levels between patient populations may offer insight into mechanisms underlying disease courses and responses to IFNβ1a therapy. This work identifies Dicer regulation as both a potential mediator of MS pathology and a therapeutic target.
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Affiliation(s)
- William J Magner
- Laboratory of Molecular Medicine, Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA; Department of Microbiology and Immunology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Bianca Weinstock-Guttman
- Jacobs Neurological Institute, Buffalo, NY, USA; Department of Neurology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Mina Rho
- Division of Computer Science and Engineering, Hanyang University, Seoul, Republic of Korea.
| | - David Hojnacki
- Jacobs Neurological Institute, Buffalo, NY, USA; Department of Neurology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Rabia Ghazi
- Jacobs Neurological Institute, Buffalo, NY, USA; Department of Neurology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Murali Ramanathan
- Jacobs Neurological Institute, Buffalo, NY, USA; Department of Neurology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Department of Pharmaceutical Sciences, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Thomas B Tomasi
- Laboratory of Molecular Medicine, Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA; Department of Microbiology and Immunology, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Department of Medicine, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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Kalafatakis K, Russell GM, Zarros A, Lightman SL. Temporal control of glucocorticoid neurodynamics and its relevance for brain homeostasis, neuropathology and glucocorticoid-based therapeutics. Neurosci Biobehav Rev 2015; 61:12-25. [PMID: 26656793 DOI: 10.1016/j.neubiorev.2015.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/09/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
Abstract
Glucocorticoids mediate plethora of actions throughout the human body. Within the brain, they modulate aspects of immune system and neuroinflammatory processes, interfere with cellular metabolism and viability, interact with systems of neurotransmission and regulate neural rhythms. The influence of glucocorticoids on memory and emotional behaviour is well known and there is increasing evidence for their involvement in many neuropsychiatric pathologies. These effects, which at times can be in opposing directions, depend not only on the concentration of glucocorticoids but also the duration of their presence, the temporal relationship between their fluctuations, the co-influence of other stimuli, and the overall state of brain activity. Moreover, they are region- and cell type-specific. The molecular basis of such diversity of effects lies on the orchestration of the spatiotemporal interplay between glucocorticoid- and mineralocorticoid receptors, and is achieved through complex dynamics, mainly mediated via the circadian and ultradian pattern of glucocorticoid secretion. More sophisticated methodologies are therefore required to better approach the study of these hormones and improve the effectiveness of glucocorticoid-based therapeutics.
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Affiliation(s)
- Konstantinos Kalafatakis
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol BS1 3NY, United Kingdom.
| | - Georgina M Russell
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol BS1 3NY, United Kingdom.
| | - Apostolos Zarros
- Research Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, United Kingdom.
| | - Stafford L Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol BS1 3NY, United Kingdom.
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